Live Well With Me

To start, my original ADP idea has been scrapped. Not due to any major reason, other than the fact that my University does not allow mixed-methods designs for their ADPs, which was a disappointment, considering my potential design received a lot of support from my potential ADP Chair. The bright side of this situation is that my current idea could be much simpler than the problem I want to solve. It will come with less stress, especially when it is time to figure out sampling procedures.

Here are the details that have not changed:

• My specialization is in criminology and justice studies, with a focus on reentry resources and mental health.
• I intend to utilize Penchansky and Thomas’s access framework to guide my research; however, this aspect is still being finalized.
• My focus is less on creating a new rural mental health reentry program and more on exploring stakeholder perspectives in areas of shortage.

Context of Research

While researching my mixed-methods idea, I came across Health Professional Shortage Areas (HPSAs) in the United States. I found that in Oklahoma, there are two major clusters of counties designated as geographic HPSAs. These HPSAs rely heavily on certified community behavioral health centers (CCBHCs) to provide behavioral health care to rural populations, especially formerly incarcerated individuals. Urban Oklahoma (Oklahoma City and Tulsa) uses reentry intensive care coordination teams (RICCTs) to provide comprehensive mental health care and other useful resources to the formerly incarcerated population, which can mitigate the case overload that CCBHCs may experience. However, rural Oklahoma (especially in HPSAs) lacks access to RICCTs, so CCBHCs serve the entire rural population in those communities.

My personal experience with this is a few years old, but I live in a rural area and decided to get some teletherapy through the local CCBHC. All went well until they decided to drop me because I wasn’t “experiencing enough crisis” for their services. Anyone with any knowledge of adequate mental health care knows that mental illness can be best mitigated with routine care and therapy. It feels like it sets the expectation that people should use mental health care on an à la carte basis, which feels wrong to me. I didn’t even live within an HPSA – this was simply a rural community.

An important component to remember is that stakeholders (parole officers and behavioral health professionals) are a large part of the population who provide services to formerly incarcerated individuals with mental illness, so working within a shortage area can have several implications, like case overload, burnout, job dissatisfaction, etc.

To my knowledge, based on the research I have conducted, there is limited information available about stakeholder experiences in areas of health professional shortage. It is well known, largely through systematic research, that these professionals experience burnout and case overload, as previously mentioned, but what about their processes? How do they work around burnout? How do they work around case overload? Do they have specific processes to handle such barriers? If so, what are those processes? More importantly, how do these processes compare to those used by areas with sufficient healthcare providers? (These are not my research questions, at least not exactly.)

Regarding HPSAs, I aim to focus my study on two distinct rural areas encompassing several counties in rural Oklahoma. This should provide me with a sufficient sample without requiring too many participants for a qualitative study, especially since some rural Oklahoma counties share criminal court districts, meaning some professionals must serve clients from other counties. Some counties may be represented by the same individual (especially for parole officers).

The real problem lies with the research. There is too little research examining how two similar yet different professions should collaborate toward a common end goal. Parole officers clearly take on a supervisory/authoritarian role that manages an individual who has been released from prison to serve parole. These professionals often make the decisions to send someone back to prison if a parolee breaks their conditions, which can include unemployment, new criminal involvement, positive drug screenings, and more. Behavioral health professionals apply to anyone in the mental health field who has connections to care navigation and mental health care for formerly incarcerated individuals or justice-involved individuals with mental illness. They usually provide advocacy and navigation to help someone connect with the services they need. These two professionals should communicate and collaborate, especially if they share a client. However, in some cases, these professionals have little to no communication with parolees, which can pose many issues for them.

Something I realized I should give more thought to is which framework to use to guide my study further. Originally, I wanted to use Penchansky and Thomas’s access framework, but now my topic has changed so much that I need to use a different framework. Now, I have settled on the Lamberti collaboration framework and role identity theory (Stryker & Burke) to guide this research because they fit well. Since conducting further research into the literature, the themes for approaching my topic have become clearer. I will explore the narrative experiences of stakeholder collaboration through the lens of workforce shortages. Role identity will help specify each profession’s responsibilities and tasks through a lens of shortage, and the collaboration framework will guide the results, assessing how well the professionals align with it. This could set the stage for further research to test the collaboration framework in areas of shortage.

Unfortunately, until my ideas are approved and published, most of my posts regarding my ADP will be somewhat vague. I am excited to share my progress, though, and I will be posting once a month (regarding my ADP) to track progress. Additionally, this will be a journey that many of you may appreciate when/if you decide to take the plunge into a doctoral degree.